What’s your sleep number?
[Rembrandt van Rijn, Sleeping Woman, 1658]
On a scale of 1 to 5 would you say that your sleep number (the quality of your sleep) is:
- nonexistent, I never sleep
- occasional, I sleep one or two nights a week
- obstructed, I sleep but I wake up regularly throughout the night
- pretty good, I rarely wake up
- great, I typically sleep through the night
If you are like most peri- post menopausal women, it’s likely that you rate the quality of your sleep about a “3. ” In fact, a review in the journal Current Neurology and Neuroscience Reports suggests that 28% to 64% of peri- or postmenopausal women have some form of sleep disturbances that may aggravated by sleep apnea, periodic limb movements syndrome (restless leg syndrome) and psychological distress (anxiety, major depression).
One of the primary causes of sleep disruption during menopause is declining estrogen levels, which increase peripheral and central temperature, dilate blood vessels and lead to hot flashes. Unfortunately data also suggest that hot flashes double the time spent awake although ironically, they often follow rather than proceed awake times.
More good news: both sleep apnea and periodic limb movements syndrome increase with age. Menopausal women are espeically at risk due to declining progesteron levels and increased body mass index (and associated increases in neck circumference). Both sleep apnea (in which the airways become partially or totally obstructed) and periodic limb movements obviously interefere with sleep quality. In fact, sleep researchers have documented apnea, restless leg syndrome or both in up to 53% of women between the ages of 44 and 56.
The evidence is less certain for mood disturbances and sleep, although studies have shown clear links between reproductive hormonal changes and clinical depression in women going through menopause. What’s more, women in menopause who are clinically depressed have reported more frequent and longer times awake than those who do not have any mood disturbances.
Steps to take
I’ve written previously on this issue and there are a variety of non-pharmacologic steps that might improve sleep quality including standardized herbs and acupuncture.
Hypnosis, relaxation techniques that include breathing and/or biofeedback) may also assist. These strategies are part of a larger approach called cognitive-behavioral therapy for insomnia (CBT-I) which in a small study, was found to significantly improve anxiety, depression, partner relationships, sexuality and hot flashes in menopausal women.
Notably, the benefit of HRT for sleep/mood disturbances remains unclear and studies are inconclusive.
As with any issue associated with menopause, it’s critical to speak to a health practitioner about the issue so that the course of therapy can be safely individualized and personalized.
What about you? How’s your sleep? And what are you doing about it?
Read MoreMind over data
Can the positive effects of mind-body medicine truly be measured by Western methodology? Does the one-size fits all paradigm work?
I stumbled across an extensive, well-designed review of the value of yoga for menopausal symptoms in the online edition of the journal Menopause. While I generally provide a link, the site is having some technical issues so you’ll need to take my word.
Mind-body interventions, e.g., yoga, have been shown to stabilize the nervous system, increase overall sense of well-being and decrease stress. Some data support its use in alleviating menopausal symptoms. However, Western researchers have not been able to find research that consistently supports these positive effects.
In the present review, researchers were able to identify 7 studies that met their criteria for critically assessing evidence demonstrating whether or not yoga ameliorated symptoms such as mood change, hot flash, night sweats, insomnia, vaginal dryness, decreased libido and impaired cognitive function, etc.
- 2 trials compared the effects of y0ga to walking or other physical exercise
- 2 trials compared yoga to wait list (guess this means that subjects were on a waiting list for yoga sessions) or no treatment
- The remaining studies were either uncontrolled (meaning that participants are given a treatment and then observed for a specific period of time) or non-randomized (meaning that all participants had the same treatment)
Most of the studies used Iyengar, integrated or restorative yoga, and participants attended yoga sessions anywhere from 2 to 3 times weekly.
Overall, the researchers found that there was not enough evidence to support yoga’s effectiveness in treating menopausal symptoms.
Note that the researchers, in their review (and to their credit), pointed out the following:
- Yoga might be ineffective or studies were not adequately designed or treatment may not have been administered optimally in the particular study setting. Additionally, the study groups may not have been suitable for treating menopausal symptoms.
- There are significant differences in the various forms of yoga, begging the question, can data be sufficiently pooled or compared?
Their overall conclusion? That “the current best evidence is not convincing to suggest that yoga is an effective treatment” for menopausal symptoms. And that “further and better research is required to investigate whether there are specific benefits of yoga for women with menopausal symptoms.”
I applaud these researchers because they recognize the many caveats of applying Western philosophy to alternative interventions. So, the jury’s still out.
Okay Jury…..What do you think? Has yoga helped your symptoms?
Read MoreYou’re getting veerry sleeepy…
Baylor University researchers report that hypnosis might represent an effective intervention for hot flashes in women with breast cancer.
Makes one wonder if mind-body treatments might represent a viable alternative for all menopausal women?
In the study, which appears in the online edition of the Journal of Clinical Oncology, 60 breast cancer survivors with hot flashes received 5 weekly hypnosis sessions or no treatment.
The women who received hypnosis reported a 68% decline in hot flash scores. Significant improvements were also observed in anxiety levels, depression, the degree to which hot flashes interrupted daily activities and sleep.
One topic which I’ve not yet addressed on Flashfree is the association between breast cancer treatments and menopause. Indeed, adjuvant therapy, which is a term used to characterize chemotherapy and/or hormonal treatments after breast cancer surgery, often launches as many as 10 to 50 percent of women younger than 40 and in 50 to 94 percent of women over 40 into early menopause. In fact, treatments for breast cancer can cause women to go into menopause in a matter of days.
The reason is that chemotherapy can damage the ovaries and affect their ability to produce normal levels of estrogen. Depending on the type of agent used and a woman’s age, it is possible for regular ovarian function to return. But for some women, early menopause may be permanent. Importantly, hormone replacement is not an option in breast cancer survivors due to an increased risk of recurrence. This makes alternatives even more important.
The results of this specific study resulted in a $2.6 million grant to Baylor from the National Institutes of Health to fund a broader study. According to Baylor, this is the largest grant ever awarded by NIH for this particular type of research.
The larger trial will enroll 180 women who entered menopause naturally and who are experiencing hot flashes. It will compare hypnotic relaxation therapy plus self-hypnosis techniques to another type of mind-body treatment.
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